Prevalence of delayed initiation of rabies postexposure prophylaxis and factors influencing it among animal bite victims from Eastern Uttar Pradesh, India.

BACKGROUND: In a rabies-endemic country like India, every animal bite is potentially taken as rabid exposure and timely and appropriate postexposure prophylaxis (PEP) is crucial as rabies is an almost 100% fatal disease. METHODS: A retrospective record-based study was conducted at an anti-rabies clinic (ARC) in Eastern Uttar Pradesh, India. Data of the animal bite victims attending the ARC for PEP from January to December 2022 were extracted from the records. A semistructured questionnaire was used for collecting information regarding the interval between exposure and the initiation of anti-rabies PEP, age, gender, residence, the bite site on the body, category of exposure and other risk factors associated with the delay in PEP. RESULTS: Most of the victims were male (67.6%), from an urban background (61.3%) and aged up to 20 y (43.9%). Out of the 222 victims, 62 (27.9%) had delayed initiation of PEP (>48 h after exposure). Factors found to be significantly associated with delayed initiation of PEP were residence (p=0.01), age (p=0.04) and the type of biting animal (p=0.002). CONCLUSIONS: Delayed initiation of PEP is common among animal bite victims in this region of India, although PEP is affordable. Educational programmes and awareness-raising campaigns for timely administration of PEP should be a priority, especially targeting rural residents, those aged<18 y and those bitten by animals other than dogs.

Mmp-9 responsive PEG cleavable nanovesicles for efficient delivery of chemotherapeutics to pancreatic cancer.

Significant differences in biochemical parameters between normal and tumor tissues offer an opportunity to chemically design drug carriers which respond to these changes and deliver the drugs at the desired site. For example, overexpression of the matrix metalloproteinase-9 (MMP-9) enzyme in the extracellular matrix of tumor tissues can act as a trigger to chemically modulate the drug delivery from the carriers. In this study, we have synthesized an MMP-9-cleavable, collagen mimetic lipopeptide which forms nanosized vesicles with the POPC, POPE-SS-PEG, and cholesteryl-hemisuccinate lipids. The lipopeptide retains the triple-helical conformation when incorporated into these nanovesicles. The PEG groups shield the substrate lipopeptides from hydrolysis by MMP-9. However, in the presence of elevated glutathione levels, the PEG groups are reductively removed, exposing the lipopeptides to MMP-9. The resultant peptide-bond cleavage disturbs the vesicles' lipid bilayer, leading to the release of encapsulated contents. These PEGylated nanovesicles are capable of encapsulating the anticancer drug gemcitabine with 50% efficiency. They were stable in physiological conditions and in human serum. Effective drug release was demonstrated using the pancreatic ductal carcinoma cells (PANC-1 and MIAPaCa-2) in two-dimensional and three-dimensional "tumor-like" spheroid cultures. A reduction in tumor growth was observed after intravenous administration of the gemcitabine-encapsulated nanovesicles in the xenograft model of athymic, female nude mice.

Acute lung disease after exposure to fly ash.

A 48-year-old man with no history of pulmonary disease developed acute lung disease after the intensive exposure of fly ash. He subsequently had progressive worsening of shortness of breath and hypoxemia to the point of requiring mechanical ventilation. Fly ash is a compound consisting of silicon dioxide and various other substances and is used in industrial settings to generate electricity. Exposure to fly ash may cause irritation to the mucous membrane of the respiratory tract and even pulmonary fibrosis in humans. To our knowledge, this is the first case report described in the medical literature of acute lung disease developing after fly ash exposure.

Determination of bone width in malnourished children under 5, and its inter relationship with mid arm muscle thickness, subcutaneous fat thickness and the mid upper arm girth.

The mid upper arm of 516 malnourished children (one to five years) were studied radiographically for changes in bone width, muscle mass and subcutaneous fat, of malnutrition at different ages. The data was studied by statistical analysis, determining the correlation coefficients of each of the factors. The findings indicate that previous assumptions about the components and the changes of the mid upper arm girth (MUG) in chronic severe malnutrition, were perhaps too simplistic.

Changing trends in mortality and morbidity in a teaching hospital in central India.

A comparison of mortality and morbidity pattern of hospital admissions of children under 14 years during 1966-68 and 1977-81 has been made. Annual admission rate has increased from 1515 to 2515, which is in proportion to the population increase of 3 lacs from 1966 to 1981. Recently more than 70% were discharged within a week as against 52% during 1966-68, indicating a faster turnover and a need for more beds. Protein energy malnutrition, infections and diarrhoea with dehydration were main killers. The pattern of mortality and morbidity has not much changed from 1966 to 81 but mortality rates at all ages have considerably declined in recent years (neonatal, post neonatal, preschool and school). Measures to decline it further have been discussed. The data should be of interest to those engaged in planning health strategies and to teachers in defining priorities in Medical education.

PIP: A comparison of mortality and morbidity patterns of hospital admissions for children under age 14 between 1966-68 and 1977-81 has been made. Annual admission rate has increased from 1515 to 2515, which is in proportion to the population increase of 3 lacs from 1966-81. Recently, more than 70% were discharged within 1 week as compared to 51% during 1966-68, indicating a faster turnover and a need for more beds. Protein energy malnutrition, infections, and diarrhea with dehydration were the main causes of death. The pattern of mortality and morbidity has not changed much from 1966-81, but mortality rates at all ages have declined considerably in recent years (neonatal, postneonatal, preschool and school-age). Measures to decrease it even further have been discusses. the data should be of interest to those engaged in planning health strategies and to teachers in order to help define priorities in medical education.

Infant feeding with commercial milk formula in an urban community of central India.

PIP: A study group composed of mothers of 250 infants who were being fed only commercial milk formula were observed in an urban Indian community. Most mothers estimated the amount of powder and water as they could not understand the directions for use of the commercial milk formula. The mothers were also purchasing daily or weekly feeding needs from open tins as they could not afford the price of full tins. The sterilization of bottles was not prevalent. Christians, as compared with Jain and Muslim communities, were more inclined to practice breast feeding. Many mothers used formula feeds because they believed they more easily digestible and better nutritionally. As well, many perceived, erroneously, that there was a greater economy to using formula feeds. Others believed that breast feeding caused liver trouble or recurring diarrhea in their infants and therefore switched to formula milk. Most of the women were influenced primarily by health personnel with only 14% being influenced by advertising. Thus, education of the benefits of breast feeding and the risks of commercial milk formula must begin within the medical schools of India and finally reach the affected population: mothers and infants.^ieng

Knowledge, attitudes and practice regarding infant feeding among mother substitutes.

PIP: With more women entering the workforce, the issue of infant nutrition has become more complex. Mother surrogates, or substitutes, are increasingly taking over the responsibility of infant care. 80 mother substitutes, aged 7-70, were interviewed in Jabalpur town, India, from October 1983-July 1984. Substitutes originated from nuclear families consisting of grandmothers, aunts, elder sisters, brothers, and servants. They were questioned concerning breast feeding, top milk initiation, feeding technique, and weaning. Results pointed to a variety of opinions on feeding practices and nutrition. 50% of younger mother substitutes and the majority of older, uneducated ones believed in initiating breast feeding from the 2nd day onward. 50% of young and 64% of older substitutes did not consider giving colostrum, and various reasons why are cited. 20% of all and 42% of highly educated substitutes were aware of the advantages of breast feeding. 65% of young and 60% uneducated did not know age of initiation of top milk. 45% advocated bottle feeding, with 25% preferring spoon feeding. With regard to "tinned milk" 40% did not use it, 25% were unaware of it, and of 30% using tinned milk, only 1/3 knew the correct technique of reconstitution. The majority of young and uneducated substitutes thought proper weaning age to be after 6 months. 50%, aged 21-40 years, believed in adding solid food from below 6 months. 90% of the young mother substitutes were against solids being introduced by the age of 4 months. A majority of the substitutes suggested weaning foods such as dal, rice, roti, and biscuits with a few considering tinned cereals as proper weaning foods. This response may point to the reason why protein and energy deficiency may be observed around weaning age in many infants throughout the 3rd world.^ieng